Clinical Research About Prognosis Of Conservative Treatment For Degenerative Lumbar Spinal Stenosis In Different Pathological Change

Degenerative Lumbar Spinal Stenosis(DLSS) is a common disease in clinic, which is one of the main reasons to low back pain of the elderly. The incidence of DLSS is second only to Lumbar Disc Herniation. The treatment of DLSS including conservative treatment and surgical treatment, while conservative treatment is the primary treatment of it. Most patients can get a certain effect through a variety of conservative treatment. In the clinical research of conservative treatment, how to further play the advantages of Chinese medicine that can ameliorate the effect of conservative treatment, is major research of degenerative spinal disease.Because of the variety of pathogenic factors and changes of DLSS, prognosis of conservative treatment is multiple. However, clinical research about prognosis of DLSS in different pathological change, particularly in terms of conservative treatment, has never been reported in clinic.ObjectiveTo compare the different prognosis of conservative treatment for DLSS in different pathological change and summarize the principle of it, that can support the clinical evidences of effect, indications and outcome of conservative treatment.MethodsClinical outcomes were classified and analyzed under different pathological changes through a retrospective survey of DLSS patients receiving conservative treatment in our hospital between 2006 and 2010. Patients were classified by different pathological changes of their imaging data and then follow-up study was made. Outcome Assessment including the visual analogue scale (VAS) and the Japanese Orthopedic Association (JOA) Scale.ResultThe study population included 355 patients that identified meeting the criteria and 331 patients (93.2%) were available for follow-up.61% of the patients (202 cases) accepted surgical treatment after experiencing an average of 7.89±7.94 months of conservative treatment, and the shortest treatment time was 1 month, while the longest treatment time was 39 months. The remaining 39% of patients (129 cases) has continued to maintain the conservative treatment until now, and the average treatment time was 23.19±10.59 months. Baseline for comparison of two groups of patients, course of disease of surgical cases was significantly longer than that of continuing conservative treatment cases(P<0.01), while the initial VAS of surgical cases was significantly lower than that of continuing conservative treatment cases(P <0.01). Due to the comparison of the initial JOA, the two groups were not significantly different (P> 0.05). The overall efficiency was designated by JOA improvement rate. Accordingly,32 cases (9.7%) were markedly effective, 76 cases (23.0%) were mildly effective,21 cases (6.3%) were ineffective, and 202 cases had accepted surgical treatment (67.3%).In total cases, stenosis level, disc degeneration level, ligamentum flavum degeneration level and facet joint degeneration level showed positive correlation to each other (P<0.01).Disc degeneration level of patients who accepting surgical treatment was significantly higher than that of patients who maintaining the conservative treatment (P<0.01). Positive correlation was also seen between overall efficiency and disc degeneration level (P <0.01). However, overall efficiency showed no significant correlation between stenosis level, ligamentum flavum degeneration level and facet joint degeneration level (P>0.05)ConclusionDegenerative lumbar spinal stenosis is a widely degenerative disease with a variety of complex pathological factors, and disc degeneration is the main factor, while the various pathological factors are positively correlated to each other. Disc degeneration level is significantly related to the prognosis of conservative treatment for DLSS. The more severe disc degeneration of DLSS patients is, the worse the effect of conservative treatment gets and surgical treatment is more likely to be a better choise. Conversely, the milder disc degeneration of patients is, the better the effect of conservative treatment becomes. Patients of DLSS can access to satisfactory outcomes through patient conservative treatment, but the rate of symptom improvement shows no significant correlation to the various pathological factors. The degree of disc degeneration plays an important rule in the strategy of conservative treatment of degenerative lumbar spinal stenosis.